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The End of the ‘Roid? JC: ADRENAL Dan Horner | January 22, 2018 from http://stemlynsblog.org/the-end-of-the-roid-jc-adrenal/ So another year, another Critical Care Reviews meeting . Rob is doing an absolutely fantastic job with these, inviting lead authors from major critical care trials to present and defend their work. In fact, this is going so well that this year he appears to have convinced the editor of the NEJM to coincide publication of one of the most eagerly await...
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Steroids in septic shock from http://www.thebottomline.org.uk/blog/steroids-in-sepsis/ We suggest against using IV hydrocortisone to treat septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability. If this is not achievable, we suggest IV hydrocortisone at a dose of 200 mg per day (weak recommendation, low quality of evidence). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Sept...
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The Definitive Word on Steroids in Septic Shock Ryan Radecki / January 19, 2018 / Resuscitation, Sepsis, Vasopressors The Definitive Word on Steroids in Septic Shock As the authors say in their introduction, glucocorticoids have been in and out of favor as adjunctive treatment of patients in septic shock for over 40 years. Various trials have found results both favoring and discounting their utility – leading, finally, to this trial to end all trials: ADRENAL. Of course, ...
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Recommended Reading from the Vrije Universiteit Amsterdam Medical Center Critical Care Medicine Fellows Mirjam Kop, Nicolas F. Schroten, Sharon Soe-Loek-Mooi, et al Am J Respir Crit Care Med Published on 18-October-2017 as 10.1164/rccm.201701-0245RR Keh D, et al. Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. The HYPRESS randomized clinical trial. JAMA (1) Reviewed by Mirjam Kop Corticosteroids have been used for the treatment of patien...
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Perspective > Critical Issues COMMENTARY The Pros and Cons of Extracorporeal Membrane Oxygenation for ARDS Aaron B. Holley, MD January 16, 2018 Using Extracorporeal Membrane Oxygenation for ARDS 采用ECMO治疗ARDS Critical Care Medicine just published a pro-con debate. One side argued for extracorporeal membrane oxygenation (ECMO) as first-line therapy for acute respiratory distress syndrome (ARDS); the other side argued against it.[1,2] I've spent the past 18 months w...
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News > Reuters Health Information Steroid Therapy Speeds Recovery From Septic Shock, but With No Survival Benefit By Gene Emery January 22, 2018 (Reuters Health) - A hydrocortisone infusion does not reduce mortality among septic shock patients undergoing mechanical ventilation, but it does speed recovery when the condition is not fatal, according to an international study of 3,658 patients treated over four years. 根据一项历时4年入选了3658名患者的国际研究结果,接受...
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Adjunctive Glucocorticoid Therapy in Patients with Septic Shock Comment Kathrin Jähne, MD | Jan 25, 2018 Interesting but once again negative septic shock trial 有趣的但结果再次阴性的感染性休克试验 Steroid use in septic shock has multiple targets: Supplement the stress hormone cortisol to overcome TEMPORARY insufficiency. Faster reversal of shock may relate to this. Shock reversal is less likely to influence the primary end-point (90day mortality) and rather a very short te...
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Can we improve the reliability of ARDS diagnosis? Failure to reliably diagnose ARDS, or acute respiratory distress syndrome, could lead to underrecognition and undertreatment in clinical practice. New research shows the reliability of the Berlin ARDS definition is "moderate," driven primarily by differences in chest imaging interpretation. The study is in press in the journal CHEST. The 2012 revision to the ARDS definition sought to improve the validity and reliability of...
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We don’t appreciate SALT Jean-Louis Vincent and Daniel De Backer Am J Respir Crit Care Med. 2017 Dec 18. doi: 10.1164/rccm.201709-1874LE To the Editor: 致编辑 In this era of personalized medicine (1, 2), it is quite surprising to see counterexamples like the Isotonic Solution Administration Logistical Testing (SALT) trial (3), a perfect illustration of the wrong use of a randomized, controlled trail (RCT). The same is true for the Plasma-Lyte 148 versUS Saline (PLUS) study...
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Perspective > Viewpoints COMMENTARY What We Can Learn From Treating Sepsis in Low-Resource Settings Gregory S. Martin, MD, MSc December 08, 2017 Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial Andrews B, Semler MW, Muchemwa L, et al JAMA. 2017;318:1233-1240 Study Summary Early and targeted sepsis resuscitation[1] has become the cornerstone of effective sepsis therapy,[2,3] yet ...
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